Neuropsychological function in patients with end-stage heart failure before and after cardiac transplantation

Abstract

This study was performed to examine cognitive function in patients with end-stage heart failure, to identify possible cardiovascular factors associated with cognitive function, and to evaluate changes in cognitive function in a subgroup of patients who received heart transplantation. An extensive battery of neuropsychological tests were given to 62 patients with end-stage cardiac failure as part of their evaluation for cardiac transplantation. Most patients were consecutive referrals, not selected because of cognitive complaints. A small subgroup of transplanted (n = 7) and non-transplanted (n = 4) patients received a repeat neuropsychological examination. At initial examination, approximately 50% of the patients met criteria for impairment in reference to normal control values. Higher stroke volume index and cardiac index and lower right atrial pressure were correlated with better cognitive function. In the subgroup of patients re-examined, the transplanted patients demonstrated significantly improved cognitive function, whereas the non-transplanted subjects were unchanged. These data indicate that in patients with end-stage heart failure there is a high prevalence of impaired cognitive function which is related to measures of cardiovascular efficiency. Preliminary evidence suggests that these impairments may be partially ameliorated by cardiac transplantation.

Associação entre evolução da função cognitiva e mortalidade após a alta hospitalar em pacientes idosos com insuficiência cardíaca avançada

“…On the other hand, Bornstein et al 9 , studying younger patients (mean age of 45 years) before undergoing heart transplantation, found a performance on the digit span test similar to that in our study (score of 4.4 ± 1.2). Newman et al 10 , studying a group of patients with atherosclerotic coronary disease but no heart failure before myocardial revascularization (mean age of 61 years), reported the score of 7.3 ± 2.3.…”

Frontal cerebral blood flow is impaired in patients with heart transplantation

“…On the other hand, previous studies [3,201 have shown that inadequate cerebral perfusion in patients with severe cardiovascular disease affects the frontal and temporal regions, and anatomical changes in the frontal lobes are the most common neuropathological finding in these patients [24]. Cognitive declines do occur after other types of surgery beside cardiac surgery, although it occurs at a lower rate than that associated with cardiac surgery [l].…”

Vascular and cognitive functions associated with cardiovascular disease in the elderly

“…Brain dysfunction secondary to cardiovascular disease was usually attributed to acute stroke during cardiac surgery (Newman et al, 2001), or in response to cardiac events (e.g., arrhythmia). Yet, patients with severe cardiovascular disease frequently exhibit cognitive problems in the absence of clinically identified stroke (Moser et al, 1999;Paul et al, 2005), particularly in cases of heart failure (Bennett & Sauve, 2003;Bornstein, Starling, Myerowitz, & Haas, 1995), presumably reflecting the impact of reduced cardiac function on the aging brain (Roman, 2004). We have previously shown that both cognitive dysfunction and structural brain abnormalities on magnetic resonance imaging (MRI) are associated with reduced cardiac output among patients with severe cardiovascular disease (Jefferson, Poppas, Paul, & Cohen, 2007a;Jefferson et al, 2007b) and abnormalities of systemic vascular function (Gunstad et al, 2006a;Gunstad et al, 2005;Gunstad et al, 2006b;Haley et al, 2007a;Haley et al, 2007b;Hoth et al, 2007).…”